File a Civil Rights Complaint

1
Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
Please enter a valid phone number.
3
Email* This field is required.
example@example.com
4
Are you the victim?* This field is required.
YESNO
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Tell us exactly what happened? * This field is required.
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Ok
6
Date and Time of the Incident * This field is required.
7
Name of the person, company, or organization that did this * This field is required.
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8
What is your end goal? * This field is required.
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9
Your race/ethnicity * This field is required.
10
How can we help? * This field is required.
Please Select
Please Select
I want a protest
I want to file a lawsuit
I need a lawyer
I need an advocate
I want a calling campaign
I want an email campaign
I want someone fired
I want a class action lawsuit
I want a vigil
I just need to talk
11
If this was a police department tell us what police department* This field is required.
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12
Do you have the officer's name and badge number pleaseTYPE N/A if this is not about a police officer
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Who are you? * This field is required.
Please Select
Please Select
The victim
Family member of the victim
Friend of the victim
Third party who does not even know the victim
Direct witness to the civil rights offense
This is hearsay
14
Select the options that you believe with your entire heart * This field is required.
Please Select
Please Select
Black Lives Matter all the time
Black Lives Matter Every day
All Black Lives Matter Every Single Day
Should be Empty: